Provider Demographics
NPI:1801932363
Name:SIMPKINS, CAROLYN WONG (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:WONG
Last Name:SIMPKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SEVEN FARMS DR
Mailing Address - Street 2:SUITE C-169
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8001
Mailing Address - Country:US
Mailing Address - Phone:843-471-2233
Mailing Address - Fax:
Practice Address - Street 1:295 SEVEN FARMS DR
Practice Address - Street 2:SUITE C-169
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8001
Practice Address - Country:US
Practice Address - Phone:843-471-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24014207R00000X
MDD59668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH92902Medicare UPIN